Historical, clinical and situational risk factors for post-discharge recidivism in forensic psychiatric patients – A Swedish registry study

Ebba Noland,Mattias Strandh

doi:10.1016/j.ijlp.2021.101749

Ebba Noland, Mattias Strandh

Open Access

https://doi.org/10.1016/j.ijlp.2021.101749

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Abstract

ObjectiveTo investigate which factors, known at the time of discharge, correlate with post-discharge recidivism in forensic psychiatric patients in Sweden. Subjects and methodsA database was constructed based on registry data taken from the Swedish National Forensic Psychiatric Register, as well as data on post-discharge convictions sourced from the National Council of Crime Prevention and demographic data from Statistics Sweden. The sample consisted of all individuals discharged from forensic psychiatric services in Sweden during 2009–2018 (n = 1150), and the follow-up period was 2009–2018. Survival analyses were used to investigate predictors of an increased likelihood for recidivism using both bivariate comparisons and multivariate Cox regression analyses. ResultsThe Cox regression analyses showed that out of the demographic background factors, higher age at discharge was significantly associated with a lower likelihood of recidivism within the follow-up period. The two discrete historical factors of having a history of substance abuse and having been sentenced before the index crime, and the clinical factor of presence of personality disorder without the presence of psychosis were associated with an increase in the likelihood of recidivism. The situational factors of having a trustee or limited guardian and main living accommodation being supported living were associated with a decrease in the likelihood of recidivism. The results support previous research regarding historical and pre-treatment factors, but also show that situational factors related to increased support and supervision in everyday life are associated with a decreased likelihood of recidivism. This knowledge may help the administrative courts and forensic psychiatric services to prevent future recidivism.

Highlights

The essential mission of Swedish forensic psychiatry is to care for the mentally disordered individual while at the same time protecting society against the mentally disordered offender
Looking at international studies of rates of recidivism, we find that a Norwegian study showed that out of 125 forensic psychiatric patients discharged from maximum security forensic units, 34% were reconvicted within eight years of discharge (Bjørkly, Sandli, Moger, & Stang, 2010)
The results support previous research regarding the importance of historical, pre-treatment factors for an increase in the risk of recidivism post discharge in forensic psychiatric patients

Summary

Introduction

The essential mission of Swedish forensic psychiatry is to care for the mentally disordered individual while at the same time protecting society against the mentally disordered offender. The risk of recidivism is one of the most important factors for the administrative court to consider when deciding if a patient should be discharged or not, which makes postdischarge recidivism a natural measurement for evaluating the success of the forensic psychiatric care. SCS means that decisions about all privileges, about the inpatient care being converted to outpatient care and discharge from the forensic psychiatric care are made by a county administrative court, not by the chief medical officer (who makes these decisions for patients without SCS). The court has to consider if there is a risk of relapsing into serious crimes due to mental disorder, and whether forensic psychiatric care is no longer needed with consideration of the patient’s mental state or personal conditions (SFS, 1991:1129). All forensic psychiatric patients in Sweden receive inpa tient care at first, but the care is almost always converted to outpatient care before the patient is discharged from the forensic psychiatric services

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